Healthcare Provider Details

I. General information

NPI: 1477093557
Provider Name (Legal Business Name): LAUREN ROBERTS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E WASHINGTON ST
IDABEL OK
74745-3325
US

IV. Provider business mailing address

515 E WASHINGTON ST
IDABEL OK
74745-3325
US

V. Phone/Fax

Practice location:
  • Phone: 580-245-7004
  • Fax: 866-531-9981
Mailing address:
  • Phone: 580-245-7004
  • Fax: 866-531-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0132066
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberA005084
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: